First Author: D.Dias PORTUGAL
Co Author(s): B. Pessoa J. Coelho M. Beirao A. Meireles
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To describe the treatment of vitreomacular traction (VMT) with two ocriplasmin injections in 4 cases of VMT.
Department of Ophthalmology of a tertiary referral centre in Oporto, Portugal - Centro Hospitalar Universitário do Porto.
Retrospective study of 4 cases with VMT were included in the study. The following parameters were evaluated: demographic data; phakic status; best-corrected visual acuity (BCVA in ETDRS letters); maximum central macular thickness (MCMT) and vitreomacular traction (VMT) initial size, VMT release rate or size reduction after treatment (measured with spectral-domain optical coherence tomography, SD-OCT) and number of intra-vitreal injections of anti-vascular endothelial growth factor (VEGF) for diabetic macular edema (DME). SD-OCT CST, traction size and functional (BCVA) evaluations were performed before and after injections.
Mean age was 68,6±7,9 years. At baseline 2 eyes were phakic. Three eyes were previously treated with intravitreal injections for macular edema; mean MCMT was 403,8±50,3µm (min. 333 µm; max. 444µm), mean traction size was 439.5 ±110.9µm (min. 324 µm; max 582 µm) and mean BCVA was 70,3±8,0 (min. 60; max. 78). Mean duration of symptoms before first visit was 4 months (between 2 and 8 months). After first injection, no traction release was observed, no significant changes in foveal thickness nor traction size were observed. Mean BCVA increased by 3,8±4,8 ETDRS letters (p>0,05) until the re-injection. Mean time until re-injection was 10,5±7,4 months. After second ocriplasmin injection, traction release was observed in 2 eyes (50%), between 1 and 3 months after treatment. In the eyes without VMT release it was seen a non-significant reduction of VMT from a mean VMT of 344,5±108,2 µm to 308,0±87,7µm. After re-injection, mean BCVA improved by 8,8±3,6 ETDRS letters and mean MCMT decreased by 57,5±39,7 µm – P>0,05. In patients with previous DME there was no recurrence of macular edema or need for anti-VEGF treatment after traction release.
In our study we found that vitreomacular traction may improve or resolve after a second injection of ocriplasmin even in diabetic patients. In our sample ocriplasmin improved macular thickness and visual acuity even in patients without vitreomacular traction resolution. In patients with previous DME and VMT under anti-VEGF therapy no recurrence of DME or need for additional intravitreal injections were seen during follow-up.